Vaccine exemption policies get second look

As the recent measles outbreak brings the vaccine debate into the national spotlight, Connecticut legislators are attempting to address the issue at the federal and state levels.

Sen. Chris Murphy announced in last Tuesday’s meeting of the Senate Health, Education, Labor and Pensions Committee that he will be introducing a federal bill to educate parents on the risks of not vaccinating their children. State Rep. Matt Ritter has called for a study of Connecticut’s vaccine exemption policies and how they compare to policies in similar states. Both initiatives aim to reverse the increasing vaccination exemption rate in Connecticut.

“Bad science has led some people to believe that there is some risk to vaccinating your child,” Murphy said at a press conference on Friday at the Connecticut Children’s Medical Center. “That is totally untrue. The risk is leaving your child unvaccinated.”

Murphy’s legislation would give incentives to states that provide additional information to parents who are seeking an exemption for their children. Five percent of the vaccination funds for states — which rely in part on federal government funding for their vaccination programs — would be conditional upon distribution of information to parents or requirements to visit a doctor before requesting an exemption.

Policies that require consultation with a doctor before claiming a non-medical exemption have been implemented in individual states. In Washington, the policy decreased the state’s opt-out rate by 25 percent, according to a column in the Los Angeles Times.

Ritter noted the discrepancy between getting a medical exemption — which requires a visit to the doctor’s office — and getting a philosophical or religious exemption, which only requires the parent to sign his name.

“We should just expect the same standard of information for a philosophical or religious exemption as we do of a medical exemption,” Murphy said.

Connecticut offers two types of exemptions, medical and religious, and no philosophical exemption. In 2003, there were 149 medical exemptions and 316 religious exemptions. Medical exemptions have remained relatively constant, with 218 medical exemptions in 2014, but the number of religious exemptions has risen rapidly, with 1,028 religious exemptions filed in 2014.

According to Ritter, parents may be filing for religious exemptions even though their opposition is more philosophically based. Eugene Shapiro ’70, professor of pediatrics, epidemiology and investigative medicine at the Yale School of Medicine, agreed, adding that it can be difficult to enforce religious exemptions and ensure that those using them are doing so for religious reasons.

“I do not believe that [in the last decade] 1,000 more families have found a religion that does not believe in vaccinations for children,” Ritter said.

Ritter, with the help of the Office of Legislative Research, will take a closer look at the effectiveness of Connecticut’s exemption policies by comparing the state’s implementation of the policies to the methods used by other states. For example, the religious exemption manifests differently in different states: Iowa requires the exemption certificate to be notarized, while New Mexico requires that an officer of a “recognized religion” that the family practices approve the exemption.

According to Shapiro, while more rigorous exemption procedures would make the process more logistically difficult, it is unlikely to dissuade many people from filing exemptions. He added that it is unclear if increased parental education would have an impact on the state’s vaccination rate. He cited the current measles outbreak as an example of personal experience being more effective at changing parents’ behavior, as some parents previously opposed to vaccinations have changed their minds.

“Anecdote is more powerful than scientific information,” Shapiro said.

While Jann Bellamy, an attorney and founding fellow of the Institute for Science in Medicine, agreed that it is difficult to predict the effect of increased education on exemption rates, she said it is the state government’s responsibility to take action based on scientific information, noting that leaving room for exemptions is not constitutionally required.

“The state has every right to protect children from infectious disease,” Bellamy said.

Ritter agreed, adding that there is precedent for the government restricting individuals’ religions freedoms in certain instances for pragmatic reasons, and he feels that the issue of vaccination falls into that category.

He added that Connecticut is trying to use the least restrictive means. The state does not require children to be vaccinated — the requirement only applies to children who are attending school in the state.

For Marietta Vázquez ’90, professor of pediatrics at Yale School of Medicine, communication with parents is the most important part of handling vaccinations. She said in an email that she rarely sees instances of religious exemptions. Parents who worry about the safety of vaccinations are far more common than those who are religiously opposed to them.

From her experience with these parents, she emphasized that it is crucial to listen to parents’ concerns and provide them with the relevant information to ensure that they understand the risks of not vaccinating their children. Parents who understand the potential risks can make an informed decision, she said.

“We aim for the perfect marriage between more conversations [that are] easy for parents to understand and laws that protect not only the rights of the unvaccinated, but also those of the vaccinated,” Vázquez said.

In Connecticut, 98.53 percent of students entering school last year were vaccinated.